Food intolerance and psychosomatic experience.
The mechanism behind food intolerance is regarded as one of the greatest enigmas in modern medicine. Its multidisciplinary modalities, sharing properties with immunologic, environmental and psychosomatic reaction patterns, make the grouping and individual approach rather complex in regard to classification of disease, diagnosis, and therapy. In this presentation, emphasis is placed on emerging knowledge about immunologic reactions in the bowel and blood circulation as a balance against the evidence for psychosomatic reactions. As a basis for discussion, the psychosomatic experience of patients with food intolerance is illustrated by a brief presentation of three studies. The first was cross-sectional. The second was prospective and controlled. The third was a double-blind placebo-controlled study using provocation with an active substance in comparison with a placebo. Both the patients and referents were characterized by interviews and scoring systems based on questionnaires. When either combined or kept separately, the results of these studies suggest a correlation between somatic and neuropsychiatric symptoms and emotional disturbances. It also seems that patients identifying themselves as sensitive to food and chemicals have higher scores for depression, anxiety, shyness, and defensiveness. On the other hand, in 62% of the cases, there was agreement between diet history and provocation. The next-of-kin of the food intolerant subjects also had various diseases more frequently, increased immunoglobulin E levels, and a higher prevalence of allergy and infectious diseases. For the same patients, major distress or trauma during childhood, as well as undifferentiated somatoform disorders, were common. In conclusion, both somatic symptomatology and self-reported psychological disturbances can be regarded as rather weak documentations. The experience within these fields today may, however, seem promising for further research. One should then emphasize the importance of the nature of exposure and the nature of disposition, represented by immunologic or psychological mechanisms, or a combination of both. Future studies should be aimed at classifying patients into subgroups through the use of improved diagnostic and clinical methods, assessment of organ sensitivity, and immunologic and psychological tests.
Vatn
M H
MH
Medical Department A, Rikshospitalet University Hospital, Department of Medicine, Oslo, Norway.
D018849:Controlled Clinical Trials as Topic; D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D005512:Food Hypersensitivity / Q000150:complications / Q000523:psychology*; D006801:Humans; D011446:Prospective Studies; D011602:Psychophysiologic Disorders / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy